PAPER III: SUBJECT SPECIALISATION PAPER for DENTISTRY (Technical Category)

ROYAL CIVIL SERVICE COMMISSION BHUTAN CIVIL SERVICE EXAMINATION (BCSE) 2014 EXAMINATION CATEGORY: TECHNICAL

PAPER III: SUBJECT SPECIALIZATION PAPER for DENTISTRY

Date : 12 October 2014 Total Marks : 100 Examination Time : 150 minutes (2.5 hours) Reading Time : 15 Minutes (prior to examination time)

GENERAL INSTRUCTIONS: 1. Write your Roll Number clearly and correctly on the Answer Booklet. 2. The first 15 minutes is being provided to check the number of pages of Question Paper, printing errors, clarify doubts and to read the instructions. You are NOT permitted to write during this time. 3. This paper consists of TWO SECTIONS, namely SECTION A and SECTION B:  SECTION A has two parts: Part I - 30 Multiple-Choice Questions Part II - 4 Short Answer Questions All questions under SECTION A are COMPULSORY.

 SECTION B consists of two Case Studies. Choose only ONE case study and answer the questions under your choice. 4. All answers should be written with correct numbering of Section, Part and Question Number in the Answer Booklet provided to you. Note that any answer written without indicating any or correct Section, Part and Question Number will NOT be evaluated and no marks would be awarded. 5. Begin each Section and Part in a fresh page of the Answer Booklet. 6. You are not permitted to tear off any sheet(s) of the Answer Booklet as well as the Question Paper. 7. Use of any other paper including paper for rough work is not permitted. 8. You are required to hand over the Answer Booklet to the Invigilator before leaving the examination hall. 9. This paper has 07 printed pages in all, including this instruction page.

GOOD LUCK!

SECTION A Page 1 of 7 PAPER III: SUBJECT SPECIALISATION PAPER for DENTISTRY (Technical Category)

Part I – Multiple Choice Questions (30 Marks)

Choose the Correct answer and write down the letter of the correct answer chosen in the Answer Booklet against the question number. E.g. 30 (C). Each question carries ONE Mark. Any double writing, smudgy answers or writing more than one choice shall not be evaluated.

1. Which is the period of most rapid growth of the skull? A. First 2 years after birth B. From 5 years after birth C. First 7 years after birth D. First 10n years after birth

2. Deep veins of the face include A. Facial B. Posterior auricular C. Maxillary D. Retro-mandibular

3. Surgical excision of the parotid gland endangers in addition to the Facial nerve, which of the following structures. A. Lesser Occipital nerve B. Spinal & auriculotemporal nerve C. Motor nerve to muscles of mastication D. External carotid artery

4. Development of body of mandible involves which of the following? A. Reichert’s cartilage B. Meckel’s cartilage C. Intra-membranous bone development D. Endochondrial ossification of Meckel’s cartilage

5. The function of Meckel’s cartilage is to: A. Produce condylar cartilage B. Attach the mandible to the malleus C. Produce temporo-mandibular joint D. Attach mandibular process and mandible to the cranium

6. The thinnest epithelium of the oral cavity is found on the A. Buccal mucosa B. Oral surface of the lip C. Soft palate D. Sublingual mucosa

7. Gingiva is different from the alveolar mucosa in that gingival has A. Stratified epithelium B. Muscularis mucosae C. Elastic fibers D. High connective tissue papillae 8. In blood chemistry, most of the magnesium in the blood is located in Page 2 of 7 PAPER III: SUBJECT SPECIALISATION PAPER for DENTISTRY (Technical Category)

A. The albumins B. The globulins C. The red cells D. The plasma

9. The primary function of the cerebellum is A. Regulation of the internal environment of the body B. Co-ordination of spinal reflexes C. Co-ordination of autonomic activity D. Co-ordination of voluntary movements

10. Which one of the following formed elements in human blood has the longest life span? A. White blood cells B. Lymphocytes C. Eosinophillic neutrophils D. Red blood cells

11. Angular cheilosis is most commonly associated with deficiency A. Riboflavin B. Iron C. Ascorbic acid D. Vitamin B12

12. A dose of 5mg of fluoride, as NaF ingested in 200ml of water at one sitting is A. Not excreted in the urine B. Readily excreted in the urine C. Only half of it is excreted in the urine, rest metabolized in liver D. None of the above

13. Fluoride intake as high as 8ppm in drinking water causes the following situation in the kidneys A. Damage to renal tubules B. Formation of urinary calculi C. Damage to renal parenchyma D. No increase in urinary calculi or any damage to the kidneys

14. Resistance to penicillin in bacteria has been shown to be caused by A. An enzyme produced by the bacterium B. The lack of pemilic acid in the cell wall C. The development of penicillin analogs in the intermediate metabolism of the bacteria D. Presence of polysaccharide capsule

15. The antibiotic effective in treating oral candidiasis is A. Griseofulvin B. Penicillin C. Nystatin D. Bacitracin

16. The microorganism that is not a frequent inhabitant of the infected pulp is Page 3 of 7 PAPER III: SUBJECT SPECIALISATION PAPER for DENTISTRY (Technical Category)

A. Streptococcus salivaris B. Streptococcus mitis C. Streptococcus mutans D. Streptococcus pyogenes

17. The fundamental principle of chemotherapy for cancer patient is A. Mutation to virulence B. Increase immunity C. Cause genetic mutation of the cancer cells. D. Selective toxicity

18. The organism least likely to be found among the normal anaerobic flora of the gingival sulcus is A. Fusobacterium B. Actinobacillus C. Bacteroides D. Mycobacteria

19. A 5 year old boy has minute white specks on the buccal mucosa opposite to first molars. A bluish red ring surrounds these spots. There is a blotchy reddish rash behind his ears and on his face. This child is suffering from A. Herpangina B. Scarlet fever C. Mumps D. Measles

20. The first change in dental caries usually starts with the loss of A. Enamel prisms B. Organic matrix C. Inter-prismatic substance D. Enamel sheath

21. In serial extraction procedure the first premolars are extracted A. After the permanent canines have erupted fully B. Before the second premolars erupt C. Before permanent canines erupt D. As soon as they erupt into the oral cavity

22. Cephalometrics in Orthodontics is most useful in diagnosis of A. Class I Type 2 malocclusion B. Class III malocclusion C. Bimaxillary protusion D. Class I Type 5 malocclusion

23. In Endodontics, the most common cause of Root canal treatment failure is A. Irritating irrigants & antiseptics passed beyond apical foramen B. Failure to sterilize the canals C. Poor condensation and improper filling of the canals D. Infection in the accessory canals with failure to sterilize them

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24. Which Kennedy classification for partially edentulous cases does not have any modifications? A. Kennedy Class I B. Kennedy Class II C. Kennedy Class III D. Kennedy Class IV

25. An upper dental arch with all posterior molars and incisors missing would be classified as A. Kennedy class I modification 6 B. Kennedy class II modification 2 C. Kennedy class I modification 1 D. Kennedy class IV modification 2.

26. When processing a mandibular denture from heat-curing resin by compression molding, porosities due to the boiling of monomer are likely to occur in the A. Mid-Buccal flange area B. Region around the necks of the teeth C. Anterior labial flange D. Posterior lingual flange

27. For Long-curing cycle the temperature and duration used to cure acrylic based denture is o A. Start at room temperature; boil to 100 C for duration of 10 hours. o B. Start at room temperature; reach to 65-74 C for duration of 8-9 hours. o C. Start at room temperature; boil to 100 C for duration of 5 hours. o 1/2 D. Start at room temperature; boil to 100 C for duration of 2 hours.

28. Syneresis and imbibition are inherent properties that effect the dimensions of A. Silicone impression material B. Impression compound C. Reversible hydrocolloid D. Irreversible hydrocolloid

29. The most cariogenic sugar is A. Fructose B. Glucose C. Sucrose D. Xyletol

30. A 45 year old patient has good oral hygiene and has 32 un-restored teeth. On examination you find the grooves on all posterior teeth are deeply stained and explorer tip catches in the groves. There is no clinical evidence of dental caries. What would be the treatment of choice? A. Pit & fissure sealants B. Amalgam restorations of posterior teeth C. Composite restorations D. No treatment required

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PART II: Short Answer Questions (20 Marks)

Answer ALL four Questions. Each question carries 5marks. Mark for each sub- question is indicated in the brackets.

1. What is an Endodontic Sealer? Write down its Ideal clinical requirements and various types of Endodontic sealers available today for clinical use along with their advantages. (1,2,2)

2. Define Dental Caries and its etiologies (three theories). Write down the progressive Sequela of dental caries if left untreated (just chart it only). (1,2,2)

3. Define Camper’s line and Frankfurt Horizontal line. What is their significance in Prosthodontic management of patients? (1,1,3)

4. You are posted in a busy city Clinic. One fine morning when one of the Towns’ School captain was guiding the morning busy traffic and helping his mates to cross the road, a car zooms from behind and throws the captain flat on the road. His Principal saws the accident and seeing him bleeding from the mouth rushes him to your clinic. He had not lost his consciousness. His friends find an avulsed tooth of the captain on the road, picks it up, rushes to your clinic and reaches in less than 10 minutes.

a. An avulsed tooth is classified into what class by Ellis? (1) b. Write down the clinical steps you would be conducting in managing to stabilize his general condition, bleeding and pain. (2) c. How would you save the avulsed tooth of the school captain? Write down the steps you would take to save this tooth. (2)

SECTION B (50 Marks)

CASE STUDY

Choose either Case 1 or Case 2 from this Section. Each case carries 50 Marks. Mark for each sub-question is indicated in the brackets.

CASE 1

A middle aged Guardsman on his 8 hour long standing duty guarding a Hospital gate suddenly loses his consciousness and falls facedown hitting his chin first. He is picked up by his fellow mates and is admitted in the emergency department. The Medical officer on duty conducts all the required procedures to stabilize his general conditions, takes X-rays of the skull and jaw bones. Both sides of his face are swollen, there are lacerations on the chin and is in pain. The Medical officer doubts fracture of jaws and sends the call to you, the Dental Surgeon on duty.

a. Where would you possibly see the fracture sites in this patient with the given history and even without the X-rays? (2) Page 6 of 7 PAPER III: SUBJECT SPECIALISATION PAPER for DENTISTRY (Technical Category) b. What is the name given to such a jaw fracture? (2) c. What are the common types of fractures in general you know? (5) d. What are favorable and un-favorable fractures of Mandible? (4) e. Describe various possible fracture sites for Mandible using a simple diagram (6) e. Describe the anatomical fracture lines for Le-Forte I, II and III fractures. (8) f. Elaborate various methods you know in reducing jaw bone fractures. Use diagram wherever possible. (10) g. What techniques would you apply in reducing bilateral fracture of body of mandible in an Edentulous patient? (4) h. Write down complications of poor reduction of facial fractures. (6) i. Write down six causes of non-union of fracture sites. (3)

CASE 2

A young adult male came to your clinic for a wisdom tooth extraction. After taking his dental history, you examined his tooth condition and advised that he should extract his tooth as it might give him repeated problem later on. The patient after carefully listening to you agreed to undergo the extraction. Your assistant has assembled the required instruments. Unfortunately, after little over 5minutes of giving him the required Lignocaine Local Anaesthesia block, your patient became very talkative and then slowly became unresponsive and fainted on the dental chair.

a. What is this condition commonly called? (2) b. What is the percentage of Lignocaine used for Dental LA and what is the maximum dose you can administer to your patient? (2) c. What is the ratio of Adrenaline:Lignocaine commonly used in dental LA?(2) d. What is Exodontia? What is NYHA? (2) e. What part of the History in this patient was neglected? (2) f. How do you manage the above case of fainting? (5) g. What are the complications that you need to rule out in this patient immediately? (5) h. What are the complications of exodontia: i. before extraction, ii. during extraction and iii. after extraction? (15) i. How do you go about managing a post extraction bleeding case that comes to you after about one/two hours of extraction? What prophylaxis would you give if your patient has mitral valve prosthesis? (5)

j. Classify wisdom tooth impactions. (5)

k. What is the pathological term for a dry socket after extraction? Explain how do you manage a case of Post extraction dry socket? (5).

***TASHI DELEK***